Current Aspects of Patient and Nursing Professional Safety in the Face of Pandemic - COVID-19

Thaisa Campos Fernandes^*
*Correspondence: Thaisa Campos Fernandes, Jeunesse Global, Sao Paulo, Brazil, Tel: 6285697918, Email:

Keywords

COVID-19 • Coronavirus • Pandemic • Patient safety • Nursing

Introduction

At the beginning of the year 2020, the world was shaken by the pandemic called COVID-19 that spread across all continents, except Antarctica. It is the coronavirus agent SARS-CoV-2 discovered on December 31, 2019 after cases registered in Wuhan, in the province of Hubei, People's Republic of China [1-5]. The Pan American Health Organization (PAHO) (2020), declared the outbreak as a Public Health Emergency of International Importance (ESPII), characterized as a pandemic. On April 15, 2020, 2,056,055 cases of COVID-19 and 134,354 deaths were confirmed worldwide, of which about 28,320 cases and 1,736 deaths occurred in Brazil [6].

VOCs belong to the group of viruses that infect humans and also birds, pigs, felines, cattle and bats [7,8]. They are classified in the order Nidovirales, family Coronaviridae, divided into four genera and can cause respiratory, enteric, liver and neurological diseases, ranging from mild to severe: alphacoronavirus, betacoronavirus, gammacoronavirus and deltacoronavirus [9-14]. There are 6 types of human coronaviruses (HCoV) identified previously, namely [14-16]: a) Alphacoronavirus: HCoV-229E; HCoV-NL63; b) Betacoronavirus: HCoVOC43; HCoV-HKU1; SARS-CoV (coronavirus that causes Severe Acute Respiratory Syndrome - SARS); MERS-CoV (coronavirus that causes Middle East Respiratory Syndrome - MERS).

According to the World Health Organization (WHO) (2020), about 80% of infected people are asymptomatic, 20% may need hospital care and 5% may progress to respiratory failure and need specialized care with mechanical ventilation [17-19]. The most common, however, non-specific symptoms related to infection with this virus are: fever (83.0% -99.0%), dry cough (59.4% -82.0%), dyspnoea (55.0% ), fatigue (tiredness) (38.1%), sore throat (13.9%), headache (headache) (13.6%) and diarrhea (3.7%). These symptoms can appear in line with the virus incubation time, on average, from 5 to 6 days after infection [20-24].

Risk groups are considered: elderly, children, pregnant women and patients with pre-existing diseases, such as diabetes, heart disease, etc. In this context, health professionals have also become a risk group, as they deal directly with the care of seriously infected inpatients. In order to protect these professionals, the Ministry of Health created several protocols and made it available on a specific portal dedicated to COVID-19 [20-24]. In addition, authorities in all countries disseminated strategies through the media to contain contagion, especially using the isolation of the quarantined population, closing companies, except those that work with basic needs services such as: gas stations, pharmacies, supermarkets , bakeries, among others.

Considering the importance of nursing in assisting the victims of COVID-19, the question is: How has nursing acted in the care of inpatients with confirmed serious cases of coronavirus? Therefore, it is intended from this study to identify the role of nursing professionals in face of the essential aspects for the provision of safe care to patients infected with COVID-19 admitted to the emergency service.

Research Methodology

Kind of study

A simple review of the literature was carried out with data collected during the peak period of the disease in real time, to build knowledge of the reality experienced by health professionals and infected people.

Study selection

To extract the information for the construction of the study, data were collected from electronic scientific bases that dealt with the theme of coronavirus and influenza and official websites of government agencies: Ministry of Health, World Health Organization, Brazilian Institute for Patient Safety, Center for Systems Science and Engineering at Johns Hopkins University, Chinese Journal of Epidemiology, among others. Notified cases, mortality rate, main spatio-temporal characteristics of disease and pandemic transmission, epidemiological features and protocols used for containment, care and prevention of real-time contagion of events were computed, that is, in April 2020.

Results

In real time, the Center for Systems Science and Engineering (CSSE) 7 at Johns Hopkins University until April 15, 2020 reported approximately 2,056,055 cases of COVI-19, in 185 locations around the world, of which 134,354 led to deaths. Table 1 shows in decreasing order the confirmed cases, the registered deaths and the notified places:

Font: JHU CSSE Online, 2020.

As shown in Table 1, the lethality rate for COVID-19 is very high (0.5 to 4% approx.). It resembles Spanish flu (2 to 3%), is higher than Influenza H1N1 (0.02%) and seasonal flu (0.1%). Despite not being absolute data, since, until now, there has been no control of the pandemic and the number of cases is increasing daily. To date, approximately 80.9% of the cases are mild and asymptomatic [25].

In February 2020, China published a report in which it was reported that infected people who do not have the main symptoms of COVID-19 were not dangerous, but all reported cases should be reported immediately through the infectious disease information system, and people remain in isolation avoiding the spread of the virus [26].

In Brazil, for the performance of nursing in a hospital environment, the measures for prevention, protection and combating the proliferation of COVID-19, included: a) use of personal protective equipment (PPE's) for direct care to suspected or confirmed patients: Surgical mask ; Capote / Apron; Procedure gloves; Eye protection (glasses or face shield); b) equipment for care in the Intensive Care Unit: Mask N95, FFP2, FFP3 or equivalent; Capote / Apron; Procedure gloves; Eye protection (glasses or face shield); Hat / cap, and both must perform hand hygiene. It is also recommended for all employees and the general population to keep a minimum distance of 1 meter between people, use of a surgical mask for circulation in other environments and on the streets, in addition to personal hygiene and packaging, accessories, etc., that have contact [27-29].

For nursing professionals working at the Material and Sterilization Center (CME), in addition to the standard precautions (PP) mentioned, in this environment, people over the age of 60, pregnant women or people with diseases with a predisposition to Imune system. All Health Products (PPS) received must be disinfected, the packaging discarded, and also any surface with 70% sodium hypochlorite alcohol, quaternary ammonium or other disinfectant indicated for this purpose. The materials must be inserted in vats and immersed in detergent, wait, then rinse under running water, dry, if necessary use brushes, according to RDC Anvisa no 15/2012 art. 68 [27].

For semi-critical articles: gastrointestinal endoscopes, endotracheal tubes, anesthesia breathing circuits and respiratory therapy equipment that come into contact with membranes, mucous membranes or non-intact skin, peracetic acid, hydrogen peroxide, among others, or as described by the manufacturer in the packaging. Materials for personal use of inpatients, such as bedpans, parrots, etc., must be sanitized outside the CME [27-29].

These measures are mandatory for the safety of the patient and professionals who work in a hospital environment or who are at risk of contamination.

Discussion

The pandemic spread across the planet reaching several locations, the delay in protection measures, detection of suspected cases and against the spread of COVID-19 caused countless deaths, as shown in Table 1. The most effective measure for the population was the quarantined isolation. Closed commercial establishments, except those indispensable to the population, such as pharmacies, bakeries, supermarkets, gas stations, among others, but under protection regime and following the protocols oriented by WHO, since it is believed that the form of transmission is droplets when the infected person coughs or sniffs.

All were instructed on the extreme importance of skin, mucosa and hand hygiene with soap and water or alcohol gel when it is not possible to wash, to avoid contact of the virus that has variable resistance surviving on surfaces such as plastic, metal, wood, these must disinfected or washed. In addition, keep the distance between people, avoid crowds and any kind of contact (hug, kiss, handshake), with control of entry and exit of people in establishments, and the requirement to use disposable protective masks or fabric washable.

The potential rate of transmission, coupled with the lack of a specific antiviral medication for the treatment [2-4,7] totaled on April 29, 2020, about 73,235 infected people and 5,083 deaths in Brazil. In April 2020, the federal government allocated 14.3 billion for actions to fight the coronavirus. Among them, acquisition of diagnostic tests, medications (oseltamivir) and equipment for the hospital network, such as vital signs monitors and lung ventilators, used in severe cases with breathing difficulties. In addition, they expanded resources for the maintenance of ICU and nursing beds, as well as the construction of the Hospital Center for Attention and Support for Clinical Research for Serious Patients, of Fiocruz, in Rio de Janeiro (RJ) [27-29].

The pandemic continued at a rapid pace across the planet, reaching 9,154,232 confirmed people in June 2020, of which 473,650 died. In Brazil, 1,106,470 were contaminated and 71,271 deaths until June 23, 2020 [7].

All the events being reported on social media and television networks generate fear and discomfort in people. Death-threatening pandemics, in addition to the typical suffering of the disease, cause lack of control of contamination, isolation in quarantine, people losing jobs, loved ones, friends and acquaintances, and everyone affected is having to deal with the stigmatization of their generated communities. for fear of contracting the disease. The mandatory use of personal protective equipment, the necessary distance between people, creates a feeling of oppression, sadness and fear. Psychological stress can cause physical symptoms, such as headaches, back pain, stomach discomfort, and others, which requires special care, good communication, welcoming, to minimize the psychological effects of COVID-19 [28-30].

Despite all the efforts of the official bodies and the solidarity of many people, COVID-19 has become a serious public health problem, especially for patient safety, since protection measures, training, isolation have not been able to save many lives , and, until the moment of the construction of this study, that is, June 2020, there is no precise diagnosis, a vaccine, a really effective protection measure, an approved vaccine released, effective measures for the prevention and control of the disease [31,32].

Conclusion

Stopping a pandemic is no easy task. However, in the case of COVID-19, it seems possible, since asymptomatic cases have not played an important role in transmission. Noticeable is the priority of protection of health professionals, isolating quarantine communicants (at least 80%), acting quickly, given the lethality of the disease and that the cases increase every day. Health facilities and professionals must be equipped and ready to handle cases. The general population must be aware of the seriousness of this moment, of its role in preventing and reducing the spread, without panic, without fanfare, just act in accordance with the protection and prevention measures to avoid economic and life losses.

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